The dramatic decline in preventable child deaths over the past quarter of a century is one of the most significant achievements in human history. The global under-five mortality rate has declined by nearly half (49 per cent) since 1990, dropping from 90 to 46 deaths per 1,000 live births in 2013. The under-five mortality is falling faster than at any other time during the past two decades. Thanks to the accelerated progress in reducing child mortality, the world saved almost 100 million children– among them, 24 million newborns – who would have died had mortality remained at 1990 rates.

Despite this admirable accomplishment, progress must be accelerated to meet Millennium Development Goal 4: Reduce child mortality. Going beyond the MDG deadline, the momentum to improve child survival must be sustained in all regions. If current trends continue, the world will not meet the MDG target until 2026.

UNDER-FIVE MORTALITY

Globally, major progress has been made in improving child survival. Worldwide, the under-five mortality rate has declined by nearly half (49 per cent), from 90 deaths per 1,000 live births to 46 deaths in 2013.

Source: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

In 1990, 12.7 million children under age five died. In 2013 that number fell to 6.3 million, a reduction of about 50 per cent. In other words, about 17,000 children under 5 died every day in 2013 – 17,000 fewer than in 1990. The global progress in reducing newborn deaths is almost as striking. Between 1990 and 2013, the number of newborn babies who died within the first 28 days of life declined from 4.7 million to 2.8 million.

The number of under-five deaths is falling steadily

Global under-five and neonatal deaths, 1990-2013 (in millions)

Source: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

The number of under-five deaths is falling steadily

Global under-five and neonatal deaths, 1990-2013 (in millions)

Source: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

Since 1990, every region has lowered its under-five mortality rate by at least 44 per cent. However, the pace and scale of regional progress varies. The two best-performing regions, East Asia and the Pacific and Latin America and the Caribbean, reduced regional under-five mortality rates by more than two thirds since 1990. The region with the highest rate of child mortality, sub-Saharan Africa, also recorded major gains, lowering the under-five mortality rate by 48 per cent.

Under-five mortality is declining in all regions

Under-five mortality rates by region, 1990 and 2013 (deaths per 1,000 live births)

Source: UNICEF analysis based on United Nations-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

Under-five mortality is declining in all regions

Under-five mortality rates by region, 1990 and 2013 (deaths per 1,000 live births)

Source: UNICEF analysis based on United Nations-agency Group for Child Mortality Estimation (UN IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

The global under-five mortality rate is falling faster now than at any other time over the past two decades. Between 1990 and 1995, the global annual rate of reduction stood at 1.2 per cent. Since then, the rate of reduction has more than tripled, rising to 4.0 per cent between 2005 and 2013.

Between 2005 and 2013, Sub-Saharan Africa as a whole reduced the region’s under-five mortality rate more than five times faster than it did between 1990 and 1995. Progress is accelerating in both Eastern and Southern Africa and West and Central Africa, although declines in child mortality have been faster in Eastern and Southern Africa. The region’s annual rate of reduction increased fivefold, from 1 per cent per year in 1990-1995 to 5.1 per cent in 2005-2013. Since 2005, only the East Asia and Pacific region managed a faster rate of reduction in under-five mortality.

Annual rate of reduction in under-five mortality rate, by region, since 1990 (%)

Source: United Nations Inter-agency Group for Child Mortality Estimation (IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

The latest data from 2013 show that sub-Saharan Africa shoulders the world’s highest under-five mortality rates. All 12 countries with an under-five mortality rate of 100 or more deaths per 1,000 live births are in sub-Saharan Africa, and 10 of these are in West and Central Africa. On average, 1 out of every 11 children born in sub-Saharan Africa dies before age 5. This is nearly 15 times the average rate (1 in 159) in high-income countries.

The highest rates of under-five mortality are concentrated in sub-Saharan Africa and South Asia

Under-five mortality rate by country, 2013

Map disclaimer: Maps on this site do not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers.Source: United Nations Inter-agency Group for Child Mortality Estimation (IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

The highest rates of under-five mortality are concentrated in sub-Saharan Africa and South Asia

Under-five mortality rate by country, 2013

Map disclaimer: Maps on this site do not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers.Source: United Nations Inter-agency Group for Child Mortality Estimation (IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

Sub-Saharan Africa and South Asia remain the regions with the greatest numbers of child deaths. In 2013, about half of global under-five deaths occurred in sub-Saharan Africa and 32 per cent in South Asia. Among the top 26 countries shouldering the burden of 80 per cent of the world’s under-five deaths, 19 are in sub-Saharan Africa.

Half of under-five deaths occur in just five countries: India (21 per cent), Nigeria (13 per cent), Pakistan (6 per cent), Democratic Republic of the Congo (5 percent) and China (4 per cent)

Under-five deaths by country, 2013

Map disclaimer: Maps on this site do not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers.Source: United Nations Inter-agency Group for Child Mortality Estimation (IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

Half of under-five deaths occur in just five countries: India (21 per cent), Nigeria (13 per cent), Pakistan (6 per cent), Democratic Republic of the Congo (5 percent) and China (4 per cent)

Under-five deaths by country, 2013

Map disclaimer: Maps on this site do not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers.Source: United Nations Inter-agency Group for Child Mortality Estimation (IGME), as published in UNICEF: Committing to Child Survival: A promise renewed-Progress report 2014, UNICEF, New York 2014.

Today much less children die from the leading causes of under-five mortality: pneumonia, diarrhoea, malaria, measles and AIDS. In 2013, 2.2 million fewer children died from these five diseases in 2013, compared to 2000.

Child deaths from leading infectious diseases have declined dramatically during the last decade

Note: For comparibility accross diseases, this report presents analysis based on UN IGME 2014, drawing on provisional analyses by WHO and CHERG in 2014. These estimates may differ, therefore, from those presented elsewhere.

Child deaths from leading infectious diseases have declined dramatically during the last decade

Note: For comparibility accross diseases, this report presents analysis based on UN IGME 2014, drawing on provisional analyses by WHO and CHERG in 2014. These estimates may differ, therefore, from those presented elsewhere.

The leading causes of death among children under age five include preterm birth complications (17 percent of under-five deaths), pneumonia (15 percent), intrapartum-related complications (complications during labour and delivery; 11 percent), diarrhoea (9 percent) and malaria (7 percent). Globally, nearly half of under-five deaths are attributable to undernutrition. Pneumonia, diarrhoea and malaria together claim the lives of 3 out of every 10 children who die before the age of 5. Many of these deaths occur in children whose immune systems are already weakened by undernutrition – globally, nearly half of all deaths among children under 5 are attributable to undernutrition. It is important to note that among all under-five deaths in 2013, 44 per cent occurred during the neonatal period. Neonatal health will need to be addressed more effectively to continue the rapid progress on overall child mortality.

Pneumonia, diarrhoea and malaria are the main killers of children under age 5, and 44 per cent of under-five deaths occur in the neonatal period

This report looks at causes of death and coverage of key interventions for mother and newborn and highlights initiatives by governments, civil society and the private sector to accelerate progress on child survival.

Recent estimates show that the number of under-five deaths worldwide has declined by half since 1990, from 12.7 million to 6.3 million today. Yet, 17,000 children under age five still die every day in 2013.

DEFINITION OF INDICATORS

Under-five mortality rate: Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.Infant mortality rate: Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.

Neonatal mortality rate: Probability of dying during the first month of life, expressed per 1,000 live births.

DATA SOURCES AND METHODOLOGY

If each country had a single source of high-quality data covering the last few decades, reporting on child mortality levels and trends would be straightforward. But few countries do, and the limited availability of high-quality data over time for many countries makes generating accurate estimates of child mortality a considerable challenge.

Nationally representative estimates of child mortality can be derived from several sources, including civil registration, censuses and sample surveys. Demographic surveillance sites and hospital data are excluded because they are rarely representative. The preferred source of data is a civil registration system that records births and deaths on a continuous basis, collects information as events occur and covers the entire population. If registration coverage is complete and the systems function efficiently, the resulting child mortality estimates will be accurate and timely. However, many countries remain without viable or fully functioning vital registration systems that accurately record all births and deaths—only around 60 countries have such systems. Therefore, household surveys, such as the UNICEF-supported Multiple Indicator Cluster Surveys and the US Agency for International Development–supported Demographic and Health Surveys, which ask women about the survival of their children, are the basis of child mortality estimates for most developing countries.

The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) seeks to compile all available national-level data on child mortality, including data from vital registration systems, population censuses, household surveys and sample registration systems. To estimate the under-five mortality trend series for each country, a statistical model is fitted to data points that meet quality standards established by IGME and then used to predict a trend line that is extrapolated to a common reference year, set at 2013 for the estimates presented here. Infant mortality rates are generated by either applying a statistical model or transforming under-five mortality rates based on model life tables. Neonatal mortality rates are produced using a statistical model that uses under-five mortality rates as input. These methods provide a transparent and objective way of fitting a smoothed trend to a set of observations and of extrapolating the trend from 1960 to the present.

A peer-reviewed collection of articles that makes a vital contribution to transparency on UN IGME's methodology for child mortality estimation.

Topics include: an overview of the child mortality estimation methodology developed by UN IGME, methods used to adjust for bias due to AIDS, estimation of sex differences in child mortality, and more. The collection was produced with support from UNICEF and the independent technical advisory group of IGME. Read more.

CHANGE IN ESTIMATION PROCESS

The UN IGME continually seeks to improve its methods. Since 2013, estimates and projections of under-five mortality have been produced using the Bayesian B-splines bias-adjusted model, referred to as the B3 model. Compared with the previously applied Loess estimation approach the B3 model better accounts for data errors, including biases and sampling and nonsampling errors in the data. It can better capture short-term fluctuations in the under-five mortality rate and its annual rate of reduction and thus is better able to account for evidence of acceleration in the decline of under-five mortality from new surveys. Validation exercises show that the B3 model also performs better in short-term projections.

Estimates of infant mortality rates are generated by applying the B3 model for countries with high-quality vital registration data. For other countries, infant mortality rates are derived from under-five mortality rates using model life tables that contain known regularities in age patterns of child mortality. This approach ensures that the internal relationships of the two indicators are consistent with established norms. Estimates of neonatal mortality rates are produced using a statistical model that uses under-five mortality rates as an input. These methods provide a transparent and objective way of fitting a smoothed trend to a set of observations and of extrapolating the trend to the present.

In 2012 the UN IGME produced sex-specific estimates of the under-five mortality rate for the first time. In many countries fewer sources provide data disaggregated by sex than for both sexes combined. So the UN IGME uses the available data by sex to estimate a time trend in the sex ratio (male–female) of child mortality rather than estimating child mortality trends by sex directly from reported mortality levels by sex. Since 2013 a Bayesian model developed by the UN IGME has been used to estimate sex ratios of child mortality, with a focus on identifying countries with outlying levels or trends.

The full details of the methodology used in the estimation of infant and under-five mortality rates for 2006 are available in the following working paper: UNICEF, WHO, The World Bank and UN Population Division, Levels and Trends of Child Mortality in 2006: Estimates developed by the Inter-agency Group for Child Mortality Estimation’, New York, 2007. Working Paper [PDF]